WELCOME!!

Chiefs’ Orientation

Dana AngeliniHiloni BhavsarBrandon KellieMorgan OberleGigi Gaudiano (Med/Peds)

June 14th, 2012

Topics: Introductions….. Who we are Roles of Chiefs UH Wards VA Wards A Typical Day on the Wards Ambulatory The Pager System Advice

Dana Angelini

Undergraduate: University of DaytonMed School: Wright State UniversityHome Town: Clinton Township, MITalent/Hobby: Baking

Hiloni Bhavsar

Undergraduate: Wright State UniversityMed School: Wright State UniversityHome Town: Dayton, Ohio

Really...born in India, moved to Dayton '94

Talent/Hobbies: Throwing dinner parties & cooking!

Brandon Kellie

Undergraduate: University of Louisville (GO Cards!)

Med School: University of LouisvilleHome Town: Murray, KYTalent/Hobby: can BBQ and speak

southern

Morgan OberleUndergraduate: University of Evansville Med School: Indiana UniversityHome Town: Paoli, INTalent/Hobby: running/working out

Gigi Gaudiano

Undergraduate: University of VirginiaMed School: University of VirginiaHome Town: Great Falls, Virginia Talent/Hobby: Cooking, chasing around

Domenic

Roles of the Chiefs Medicine Chief Residents:

Rotate every three months UH Chief #31250 – Morgan Oberle

Office in Lakeside 3 VA Chief #31533 – Brandon Kellie

Office on 4th floor VA Ambulatory Chief #31529 – Hiloni Bhavsar

Office on 4th Floor VA Quality & Pt. Safety Chief #36644 – Dana Angelini

Office on 4th Floor VA/Lakeside 3 Med-Peds Chief #37297 – Gigi Gaudiano

Office in Lakeside 3

Roles of the ChiefsWe are the advocates for the residents

Call us with problems or issues that ariseTimely and specific please…we can’t help

you if you don’t let us know.

We are your mentors We provide support for your professional

development, education, and your psycho-social well-being

We have candy! (Morgan may have granola bars or celery! )

UHUH Campus

UH Wards 8 Medicine Teams

Wearn – General Medicine

Naff – General Medicine

Dworkin – Gastroenterology

Carpenter – Infectious Disease, General Medicine

Eckel – Nephrology and HTN

Hellerstein – Cardiology

Ratnoff – Hematology and Oncology

Weisman – Hematology and Oncology

2 ICU'sMICU & CICU

UH Wards – Sister Teams

Naff Wearn

Carpenter Dworkin

Weisman Ratnoff

Sister teams alternate long call days; each team has 2 interns leading to Q4 “long” call

UH WARDS

•Hellerstein

•Eckel

• Each team has 4 interns rotating on Q 4 “long” call

• No “sister” team

UH WARDS•UH MICU

o2 teams with 2 attendings and 2 fellows; each team with 2 residents and 2 internsoQ 4 long call for interns and seniors (seniors take overnight call)o“Helper” day is your seniors post call day (will sign out to you around 10 AM

•UH CICUoAct as “helper” can follow and admit patientsoNo formal call

•Night Floato3 interns scheduled; 2 present each night; cover the 8 inpatient UH teams

Other UH RotationsNeurology

2 week rotation on the Neurology consult service

GI-JeopardyRotate on GI consult service but are on

call for back up for any absence on UH or VA wards/clincs

MUST have pager on and answered 24/7

LOGISTICS of Calls... Long call – 3 patients by 7pm

Only 1 patient after 6 pmMedium call – 2 patients by 4pmShort Call:

UH: 2 Patients (nightfloat admit or unit transfer) VA: 2 Patients (nightfloat, transfer or NEW)

Long Medium Short HAPPY!

LOGISTICS: No. of PatientsUH:

10 patient cap on all UH ward rotations EXCEPT Ratnoff and Weisman which will cap at 8 (rolling cap)

Your short call day will also cap at 8 (based on number of patients you start with in AM; not rolling)

At VA: Cap=8 all the time

cCall and continuity clinic

No Clinic on Long or Medium call.

No short call patients assigned on your clinic day.

Days OFF• Dworkin, Carpenter, Wearn, Naff, Ratnoff, Weisman, and VA Wards

o Short or Happy days that fall on Saturday or Sundayo “Golden” = both weekend days offo “Black” = work both weekend dayso Either Sat or Sun off

• Eckel or Hellersteino 1 day off per week: “Happy day” Friday through Monday

Days OFF

•Night Floatso UH: 3 interns are scheduled but only 2 are on each night; work out days off with each other!

o VA: Saturday night is off

•UH MICUo Short call day off Friday through Monday

UH Team Pagers

Each team (Eckel, Wearn…) will have a pager held by the on call and nightfloat interns

Will mostly be paged by nursing regarding patient issues; not sure the answer???? Just ask your senior!!

Team pagers are also code pagers – on call interns should go to all codes (‘Code Blue’)

Team pager numbers are listed on the pager card in your bags.

Meet the DACR/NACR/MAN…

Day Acting Chief Resident/Night Acting Chief Resident/Medical Admitting Nurse

Role is to distribute admissions, run codes and overall monitor the daily flow of the internal medicine inpatient service

Available 24 hours/day at pager 30512 to answer questions or provide assistance!

Conferences - UHIntern Morning Reports – Residents hold the pagers!!

• Tuesday AM report from 10:30 – 11am! ** NEW ** • Thursday 10:30am-11:30am

Grand RoundsTuesday 12-1pm

Morbidity & Mortality (M&M)Friday 12-1pm

Agre SoceityMonthly, Wednesday evenings – more info to come

Noon Conference Monday, Wednesday and Thursday 12-1pm (with food)

UH Miscellaneous Dictating – Interns must dictate discharge

summary for each patient discharged on the DAY OF DISCHARGE

Day of Discharge note = progress note + discharge summaryDictation number must be written in the

chart on the day of discharge Do them as soon as you write the discharge

order Residents must do Discharge summaries

when Intern has the day off

UH Miscellaneous

GME Housestaff Lounge!!Located on Lakeside 6th floor, next to GME officeHas coffee, bathrooms, T.V., foosball table,

computers, food on Sunday nights

THE P.I.T. Fitness CenterBasement of Lakeside Free card entry, TV's, towel service, open 24/7!

Duty Hours etc.16: 80: 4 Rule!

16 hours per long call 80 hours per week 4 days off every month

Long call every fourth day 3 admissions by 7 PM, out by 9 PM, must be out by

11PM

Medium Call – 2 admissions by 4 pm, stay and signout team to intern nightfloat at 7pm

UH Resources

The Chief ResidentYour Senior ResidentThe DACR/NACROther ResidentsThe Night Floats

Louis Stokes Veterans Administration Medical Center

VA Wards Four General Medicine Teams

Blue, White, Green & Orange 1 resident + 2 interns per team – may have

acting interns/medical students Ward 4A: Orange/White (sisters) Ward 4B: Blue/Green (sisters) PCU: telemetry 2nd floor

VA Lounge and Call Rooms

Located on the 2nd floorFour call rooms (bunk bed room for AIs)Fridge: frozen dinners, ice cream, sorbet,

string cheese, muffins, fruit, yogurt, milk, PBJ un-crustables

Coffee machineCabinets have: Trail mix, gold fish, peanut

butter crackers, pretzels!

The VA MICU2 resident (day and night), 3 intern teamQ3 call

Admit from 7am to 8pmLeave by 10 pmNo overnight here either!Day off is “pre call” day Friday through

Sunday

Urgent Care Center (UCC)

The VA “Emergency Room”Staffed by at least 5 residents

One or two attending physiciansHours are 9-6 with “on-call” resident to arrive

at 0800 (you will not be the “on-call” resident this year)

Fast track: sees low acuity issues, med refills….

Intern Saturday Coverage

One or 2 Saturday Nights when on ambulatory, UCC, or elective, you will be asked to cover from Saturday 7pm to Sunday 8am for the VA intern nightfloat to get a night off.

VA ConferencesMonday: Noon conferenceTuesday: Grand Rounds televised from

UH at noonWednesday: M&M at noonThursday: Intern Morning Report @ 10am-

11am! Your resident will take your pagerBe on time!!

Friday: Noon-conference

VA Miscellaneous

Garage parking is free! Just need to get a parking pass from VA police dept

VPN access for home CPRS accessCodes at VA are called ‘Dr. Heart’

A typical day on the wards 7am to 7:45am:

Pick up signouts in KACR (at UH – Tower 5) or from intern nightfloat team (at VA you will meet up with VA nightloat intern)

Pre-round 7:45-8am: Be in your team room to discuss changes

overnight and the day’s plan with your senior 8am to 10:00am (VA) or 10:30am (UH): Rounds with

attending New patients – present H&P

Present the pertinent data, remember you only have 2 hrs for rounds

Old patients – present new data, events overnight and then your assessment and plan

Your A/P may be right or wrong but the best way to learn is to take a shot – don’t just present the data and then look at your attending and resident and wait for them to tell you what to do

Be organized—”have a system”

10:00-12:00: Time to get C.O.L.D.

C: Call your consults The later you call, the more angry the consultant will be

O: Order Entry Enter any orders that were not entered on rounds

L: Labs Run your labs!

D: Discharges Get them out! At UH, dictate your day of discharge note in your discharge

summary At the VA, type the discharge summary on the day of

discharge

A typical day on the wards (cont) 10:30 - 11:30 (UH) or 10:00 - 11:00 (VA)

Resident AM report (M/W/F at UH, T/W/F at VA)Thursday morning: Intern AM report

Noon-1PM: conference Afternoon reserved for notes, procedures,

teaching rounds, contacting families, following up studies

short call should sign out to their co-intern who is long at 5pm

medium call signs out to nightfloat at 7pm Long call signs out to nightfloat at 9pm

Ambulatory Medicine

Continuity ClinicUrgent Care Center/Firm UrgentPrimary Care BlockClinical Skills Block (CSB)

Continuity Clinic

One afternoon per week at either the VA or the Douglas Moore Center at UH.During ambulatory or elective, up to 2 clinics per week

Always the same day each week and with the same attending preceptors

You will develop a set of patients that you follow over 3 years

Clinic cannot be canceled by anyone except the Ambulatory Chief Resident

Continuity Clinic Rules No clinic when

Medium call or on long call daysVacationHolidaysICU’sNight Float

You DO have clinic when on Elective!!! Cannot switch clinics amongst yourselves; all

schedule changes need to be approved by ambulatory chief resident

Primary Care Block Introduction to Outpatient Primary Care Introduction to DMC and the Firm Continuity

Clinics Morning Clinical Conferences: 8am Daily 8:45-12:00: Clinics VA Firm A & B Mon – Thurs

RheumatologyDiabetes, Renal, HTNEndocrinologyDermatologyWomen’s Health

Friday AM – Introduction to Quality & Pt. Safety Curriculum

Primary Care Block (cont.)

Afternoon Didactic SessionsQuality and SystemsCardiovascular HealthObesityManaging Difficult PatientsPatient SafetyProfessionalism and WritingPhysical DiagnosisCommon Ambulatory Disease Presentations

Clinical Skills Block

2-week outpatient rotationHands on activitiesSimulation models at the simulation skill

centerHumanities in MedicineEnd of life careCultural Competencies

The NIGHTFLOAT TEAM

The NIGHTFLOAT TEAM

NACR

Nightfloat Resident Nightfloat Resident

Nightfloat Intern Nightfloat Intern

NIGHTFLOAT TEAM

The Nightfloat intern

The Nightfloat Intern comes in at 7pm receives the pagers from the non-call teams

The Nightfloat Intern can receive the pagers from the on-call intern at 9pm and must receive the pager by 11:00 pm

Night Float Duties

Follow up on unfinished tasks

Answer pagesSee patients when necessary (must

document brief note in chart when you see a patient)

Admit up to 2 patients from 8 pm – 5:30 am

If you have questions – please please ask your nightfloat resident or NACR!!!

Call senior for every CODE WHITE

Electives

You have continuity clinic during elective Your should be answering your pager from 8 to 6 (M-F),

no exceptions (unless on approved away elective) Must attend all conferences (GR, M&M, noon

conferences at the VA) Otherwise, you can choose to do research, a clinical

elective on a consult service, or even an ICU rotation. You have to inform Barb before starting what you will be

doing on your elective time . If you do research or away elective, you need to identify

a faculty mentor and should present your work at the Department of Medicine Research Day at the end of the year.

The Pager System UH:

1. Dial 2222. Wait for beep3. Enter pager number4. Wait for 3 beeps5. Enter your phone number, then TAG the page (press

star, then your own pager number) From the outside, dial (216) 207-7244, then

enter the pager number and follow remainder of protocol

The Pager System (cont.)

Text paging:Go to hospital directory website and select send a

text-page from the menu on the left hand side of the screen (also possible to access remotely through physician portal or amion)

VA:

1. Dial 9-207-7244

2. Follow the UH protocol

Professionalism Policy

For call-offs of more than 2 consecutive days or more than 2 days in an academic year you will be required to have a physician’s note. You can be seen by an attending physician same day in the Family Medicine Bolwell clinic.

Any call offs > 2 days, you will get extra weekend jeopardy or coverage

Friendly Advice

Catch up on your sleep when you have a chance

Talk to a chief or program director before personal problems get out of hand – we are here for you!

SUPPORT EACH OTHER!

Friendly Advice

Maintain personal and family relationships outside of the hospital; make new friends while you’re here

Take care of yourself; it’s the only way you will be able to provide good care to your patients

Things to do in Cleveland Indians Cavs Browns Lake Erie Monsters East 4th West 6th

West Side Market Little Italy Art Museum Bodies Exhibit Edgewater Park Metroparks Zoo

www.clevelandindependents.com www.coolcleveland.com

Goodtime 3 Wineries Great Lakes Brewery Larchmere Shaker Square Chagrin Falls Lakeview Cemetery Rock and Roll Hall of

Fame Cleveland Orchestra Blossom Music

Festival Lola

Winking Lizard Panini's Cain Park Luna Bakery Playhouse Square Aurora Outlets Cedar Park Kalahari Water Park Put n Bay Kelley’s Island Air show Rib Festival Etc Etc

Final Thoughts

SCHEDULES!

GOOD LUCK!

Please call us if you need us, we are here to help!!!!!